1225. Hepatitis B Immunization in Pediatric Solid Organ Transplant Recipients
Session: Poster Abstract Session: Transplant Screenings and Evaluation and Empiric and Pre-Emptive Therapy
Friday, October 9, 2015
Room: Poster Hall
Posters
  • Slide1.jpg (1.2 MB)
  • Background: Pediatric solid organ transplant (SOT) recipients represent a vulnerable population with respect to vaccine-preventable illnesses (VPI). Both the underlying medical condition and the transplant itself result in significant delays in the administration of routine immunizations, as well as inadequate seroprotection due to the loss of immunologic memory. We sought to describe the pre-transplant immunization status and post-transplant humoral immunity against hepatitis B in a cohort of SOT recipients. 

    Methods: We performed a retrospective chart review of all actively followed liver, kidney and cardiac transplant recipients in a tertiary-care pediatric hospital (1997 to 2015). We included all children ≤18 years who had data available on: (1) pre-transplant hepatitis B immunization status; (2) post-transplant residual hepatitis B serology at 1 year post-transplant.

    Results: Of 114 actively followed SOT recipients, 96 children had information on pre-transplant immunization status. Median (range) age at SOT was 3.1 (0.1-18.5) years, and 49 (51%) children had complete hepatitis B immunization (3 or more doses) before transplant. In the post-SOT analysis, we had to exclude 12 patients. At a median of 12 (6.4-21.1) months post-transplant, residual hepatitis B serology was available for 61 of 102 (60%) children who had not received any booster dose since transplant. Of these, 33 (54%) had an anti-HBs titer greater than 10 IU/L. Of 32 children who had complete hepatitis B vaccination pre-transplant, 11 (34.4%) had an anti-HBs titer below 10 IU/L at a median of 12 months post-SOT. 

    Conclusion: Pediatric SOT candidates are poorly immunized against hepatitis B before transplant. Among those adequately immunized before SOT, seroprotection was low after transplant. Reasons for this may include a non-response to the primary hepatitis B vaccine series, or loss of anti-HBs as a result of immunosuppression. These findings highlight the importance of a systematic approach to immunization both before and after SOT in pediatric patients.

    Helena Evangeliou, MD1, Léna Coic, MD1, Adela Barbaros, MD1, Bruce Tapiero, MD1, Chantal Buteau, MD1 and Fernando Alvarez, MD2, (1)Department of Pediatrics, Division of Infectious Diseases, CHU Sainte-Justine – University of Montreal, Montreal, QC, Canada, (2)Department of Pediatrics, CHU Sainte-Justine - Division of Hepato-Gastroenterology, Montreal, QC, Canada

    Disclosures:

    H. Evangeliou, None

    L. Coic, None

    A. Barbaros, None

    B. Tapiero, None

    C. Buteau, None

    F. Alvarez, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.